急性等容血液稀释对单肺通气期间组织氧合的影响  

Effects of acute normovolemic hemodilution on systemic oxygen delivery and consumption during one-lung ventilation

作　　者：王昊[1] 乔瑞冬[1] 季中华[1] 周志伟[2] 欧兴义[3] 

机构地区：[1]暨南大学医学院第三附属医院(珠海市人民医院)麻醉科,珠海市519000 [2]暨南大学医学院第三附属医院(珠海市人民医院)心胸外科,珠海市519000 [3]暨南大学医学院第三附属医院(珠海市人民医院)检验科,珠海市519000

出　　处：《临床麻醉学杂志》2009年第11期957-959,共3页Journal of Clinical Anesthesiology

基　　金：珠海市科技局基金项目(项目编号:PC20061072)

摘　　要：目的观察急性等容血液稀释(ANHD)对组织氧合的影响。方法60例ASA I或Ⅱ级择期单肺通气(OLV)胸科手术患者随机均分为三个ANHD组:HD1组,目标Hct为35%;HD2组,目标Hct为30%;HD0组不进行ANHD。连续监测ECG、BP、中心静脉压(CVP)及心输出量(CO),于ANHD前(T1)、ANHD后30 min(T2)、OLV 15 min(T3)、OLV 30 min(T4)测量动静脉血气及血乳酸(Lac),并计算心脏指数(CI)、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)。结果三组各时点Na+、K+、Ca2+、pH及BE无明显改变。ANHD后CI明显增加,OLV后CI继续增加(P<0.05)。ANHD后DO2增加;ERO2于OLV时均有增加(P<0.05)。结论适度ANHD(Hct>25%)在OLV胸科手术中能保证机体代谢的氧合需要,维持血流动力学及内环境的稳定。Objective To evaluate the effects of acute normovolemic hemodilution （ANHD） on systemic oxygen delivery and consumption during one-lung ventilation（OLV）. Methods Sixty ASA Ⅰ or Ⅱadult patients undergoing elective thoracic surgery under OLV were randomly divided into there groups 20 cases each： ANHD with target Hct of 35% was performed in group HD1, that of 30% in Group HD2. ANHD was not used in Group HD0 as the control. ECG, BP, central venous pressure （CVP） and cardiac output （CO） were continuously monitored. Arterial and central venous blood samples were taken for blood gas analysis and determination of lactic acid concentration （Lac） before ANHD （T1） ,at 30 min after ANHD（T2 ）, 15 min （T3） and 30 min after OLV （T4）, cardiac index （CI）, oxygen delivery （DO2）, oxygen consumption （VO2） and oxygen extraction ratio （ERO2） were calculated as well. Results electrolytes, pH and BE were kept stable throughout operation. There were no significant changes in HR, BP and CVP, but CI magnified after ANHD. And from OLV, CI could further step up. DO2 was increased after ANHD. During OLV, DO2 were decreased compare with that during two lung ventilation. ERO2 was increased during OLV（P〈0. 05）. Conclusion The stable bemodynamics and balanced oxygenation metabolism can be maintained by moderate degree of ANHD in patients undergoing OLV.

关 键 词：急性等容血液稀释 单肺通气 氧供 氧耗 

分 类 号：R614[医药卫生—麻醉学]